648456

research-article2016
JHNXXX10.1177/0898010116648456Journal of Holistic NursingEmotional Freedom Technique / Rancour

jhn
Practice

The Emotional Freedom Technique

Finally, a Unifying Theory for the Practice of Journal of Holistic Nursing
American Holistic Nurses Association
Holistic Nursing, or Too Good to Be True? Volume XX Number X
XXXX 201X 1­–7
© The Author(s) 2016
10.1177/0898010116648456
Patrice Rancour, MS, RN, PMHCNS-BC http://jhn.sagepub.com
Integrative Medicine, The Ohio State University Wexner Medical Center

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief
of psychological and physical distress that patients often bring to the attention of nurses. Frequently
referred to as “tapping,” this technique combines the cognitive reprocessing benefits of exposure and
acceptance therapy with the energetic disturbance releases associated with acupuncture and other
energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98%
efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder,
phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders,
etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encoun-
tered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that
patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are
seeking whole person approaches for the healing of a wide variety of psychological and physical condi-
tions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case
studies are also included.

emotional freedom technique (EFT); healing modalities; energy-based therapies; energy

Keywords: 
work; healing modalities

Introduction and Definition Implications for nursing practice, education, and

research will also be identified.
A basic tenet of holistic nursing is the inter- EFT is a branch of comprehensive energy psy-
relatedness between mind, body, and spirit. Since chology that has evolved since the 1970s from a
the field of psychoneuroimmunology has contrib- variety of sciences. These include traditional Chinese
uted a font of knowledge as to how consciousness medicine (acupuncture), Dolores Krieger’s and Doris
affects anatomy and physiology, and vice-versa, Kunz’s energy work, applied and behavioral kinesiol-
this is no longer a contested theory in the life sci- ogy, thought field therapy, meridian-based psychol-
ences. What remains problematic is how to thera- ogy, neurolinguistic programming, and energy
peutically improve health and promote healing on medicine to name but a few. The concepts defined
the emotional, spiritual, mental, and physical lev- as EFT herein have been elucidated by Craig since
els simultaneously. the 1990s and are described in his highly detailed
The purpose of this article is to introduce and online tutorial. Craig (2016) encourages those new
define “The Emotional Freedom Technique” (EFT),
also known as tapping, as a holistic nursing interven-
tion that can be used for a variety of psychological Author’s Note: All material is based on the body of work devel-
and physical conditions. The clinical technique and oped to date by Gary Craig. For more information, see http://
www.emofree.com/. Please address correspondence to Patrice
mechanism of action will be described, and a litera- Rancour, MS, RN, PMHCNS-BC, 1978 Glenn Avenue,
ture review will demonstrate its evidence base. Columbus, OH 43212; e-mail: rancour.1@osu.edu.

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2  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX

to EFT to explore Optimal EFT on his website as a sion (Church, De Asis, & Brooks, 2012; Stapleton,
more evolved spiritual iteration of the EFT process. Church, Sheldon, Porter, & Carlopio, 2013;
EFT is a clinical intervention whereby one Stapleton, Devine, Chatwin, Porter, & Sheldon,
focuses one’s awareness on a specific issue, whether 2014), and phobias (Baker & Siegel, 2010; Salas,
it be physical or psychological, while simultaneously Brooks, & Rowe, 2011; Temple & Mollon, 2011),
stimulating selected acupoints along meridians in the including fear of public speaking (Fitch, Schmuldt,
body, primarily on the head and upper torso, by tap- & Rudick, 2011; Jones, Thornton, & Andrews, 2011;
ping on them with fingertips. Each acupoint carries Schoninger & Hartung, 2010). The use of EFT to
specific releases, such as trauma, fear, overwhelm, intervene with physical conditions is just as wide-
rage, and so on (Montgomery, 2016). Properly done, spread and diverse and includes diverse problems
EFT appears to release disturbances in the energy such as psoriasis (Hodge, 2011), seizure disorders
meridian, thereby balancing the system as a whole. (Swingle, 2010), fibromyalgia (Brattberg, 2008),
In this way, the body’s stress response can be recon- headache (Bougea et  al., 2013), and sports perfor-
ditioned and learn to respond to triggers without mance enhancement (Church, 2009; Church &
stimulating the sympathetic nervous system. Downs, 2012; Llewellyn-Edwards & Llewellyn-
Frequently, EFT is referred to as “tapping.” Edwards, 2012; Rotheram, Maynard, Thomas,
Bawden, & Francis, 2012) to name but a few.
As one can see from the aforementioned list, the
Literature Review
sheer breadth of conditions for which this approach
There have been well over 60 studies in peer- has been found to be rapidly effective begs the ques-
reviewed journals establishing a 98% efficacy rate tion as to whether it is indeed just “too good to be
for EFT. Many of the studies described below are true.” Furthermore, this appears to be the case even
listed on the Association for Comprehensive Energy when investigators return for retesting months after
Psychology’s (2014) website, which provides a com- the intervention and determine that the effect has
prehensive research review. The range of problems been sustained over time. Western medical practi-
for which EFT can be used is constantly being tioners may indeed express skepticism as this tech-
tested. Two excellent review articles include nique does indeed lie so far outside the boundaries
“Acupoint Stimulation in Treating Psychological of allopathic paradigms of health and healing. This
Disorders: Evidence of Efficacy” (Feinstein, 2012) skepticism remains despite the proliferation of dou-
and “Clinical EFT as an Evidence-Based Practice for ble-blind randomized controlled studies, the gold
the Treatment of Psychological and Physiological standard of research investigation that demonstrates
Conditions” (Church, 2013). a high evidence base for EFT.
The diversity of psychological problems success-
fully treated include, but is not limited to, anxiety Mechanisms of Action
(Gaesser, 2014), addictions (Church & Brooks,
2014), posttraumatic stress disorder (PTSD), both EFT is based on the premise that the cause of all
individual and large-scale trauma events (Boath, emotional and physical dis-ease is a disruption in the
Stewart, & Rolling, 2014; Church & Brooks, 2014; body’s energy system. This presumes that a distress-
Church et  al., 2013; Church & Feinstein, 2012; ing memory of an event is not the trigger of the
Church, Pina, Reategui, & Brooks, 2012; Connolly individual’s pain, but instead, the distressing mem-
& Sakai, 2012; Dunnewold, 2014; Gallo, 2013; ory becomes a disruption in the body’s energy sys-
Gurret, Caufour, Palmer-Hoffman, & Church, 2012; tem, and it is the disruption that causes the symptom
Hartung & Stein, 2012; Karatzias et al., 2011; Lake, or condition. This explains why a unitary technique,
2014; Robson & Robson, 2012; Sheldon, 2014; EFT, can be applied to such a wide array of problems
Stein & Brooks, 2011; Zhang, Feng, Xie, Xu, & since all the problems are the result of an energy
Chen, 2011), dyslexia (McCallion, 2012), academic disruption in the system and the intervention is
performance (Boath, Stewart, & Carrier, 2013; Jain designed to release those disruptions.
& Rubino, 2012), weight loss and cravings (Church According to allopathic models, the stress
& Brooks, 2010; Stapleton, Sheldon, & Porter, 2012; response generates systemic inflammation by acti-
Stapleton, Sheldon, Porter, & Whitty, 2010), depres- vating the hypothalamus–pituitary–adrenal axis

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 Emotional Freedom Technique / Rancour   3

(Church, 2013). In normal situations, this response •• Release of serotonin, γ-aminobutyric acid,
subsides once the survival episode is completed. In and beta endorphins posttreatment.
many individuals, however, the stress response con- (Regulation of stress response through the
tinues to activate, releasing even more stress hor- hypo-thalamus-pituitary-adrenal axis.)
mones, such as cortisol, norepinephrine, and •• And evidence even exists for EFT’s effects
adrenaline, into the system. This repeated stimula- on epigenetics and gene expression
tion produces increased activation of the amygdala, (Feinstein & Church, 2010)
hippocampus, and other brain areas associated with
fear and distress (Feinstein, 2012). Unless these Contraindications/Safety
feedback loops are interrupted, the stress response,
with its attendant physical and psychological conse- As of 2013, more than 1,000 respondents have
quences, can often continue unimpeded, resulting participated in institutional review board–approved
in chronic inflammatory conditions. studies without one single adverse event reported, so
EFT works on cognitive and energetic levels the risk of abreaction is very low. EFT is safely
simultaneously. While holding the troubling symp- administered by a therapist, coach, grass roots health
tom or condition in one’s conscious awareness and educator, or as a self-help tool to one’s self or family
concurrently tapping on selected acupoints, a cogni- members. It can be safely administered one-on-one,
tive shift and an energetic release are produced. in group settings, online, or even in the field during
Feinstein (2012) elaborates, large-scale disasters, such as used by organizations
like Capacitar (http://www.capacitar.org/). EFT is
Bringing to mind an emotional trigger, problematic safely delivered to people of all ages. Mucillo (2016)
scene, or unresolved traumatic memory activates prescribes EFT for children who have problems with
the amygdala, arousing a threat response. Stimulating test anxiety and performance, fear, phobias, bedwet-
selected acupoints . . . simultaneously sends deacti- ting, nightmares, sleep problems, stress, school
vating signals by reducing the arousal while the trig- problems, sports anxiety performance fears, learning
ger is still mentally active. The hippocampus records difficulties, and self-esteem. While efficacy rates
that the memory or trigger is being safely engaged can vary from individual to individual, the fact that
without a stress response, and the neural pathways so many studies report high rates of efficacy (98%)
that initiate the associated stress response are per- with so little contraindication makes it difficult to
manently altered. Being able to encounter the mem- not trial it when compared with other interventions,
ory or trigger without limbic arousal becomes the the risks of which appear so much more problematic
new normal. (p. 16) (Church, 2013).

Supporting this proposed mechanism of action, Clinical Procedure

Church identified the following test results associ-
ated with EFT treatment: The patient is asked to rate the presenting prob-
lem on a scale of 0 to 10 so that testing of effective-
•• EEG confirmed a reduction in the frequen- ness can proceed throughout the administration of
cies of brain waves associated with PTSD. the intervention. The patient is then asked to hold
•• EEG increased theta frequencies associ- the troubling symptom or condition in his/her con-
ated with relaxation. scious awareness while developing a set-up phrase
•• EMG revealed significant relaxation of the during the initial tapping at the karate chop acu-
trapezius muscle. point, as shown in Figure 1. The basic statement
•• fMRI demonstrated changes in the regula- sounds like: “Even though I (name the problem), I
tion of the fear centers in the brain. (The completely and deeply accept myself.” Examples of
amygdala and other fear-processing cent- such issues might include “Have migraine pain at a
ers of the nervous system are regulated as level of 9 on a scale of 0 to 10,” “Am afraid I will
stress-laden emotions are calmed.) stutter during my presentation today,” or “Can’t
•• Cortisol levels significantly dropped post- sleep at night because of flashbacks of my uncle
treatment. attacking me in my bedroom when I was 7 years

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4  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX

might sound like “residual migraine pain of 4,” “fear

of stuttering,” or “can’t sleep at night.” Such mental
activation of the problem issue is a form of exposure
therapy as well as acceptance therapy. The trigger is
identified and accepted—not resisted. There is no
need to remember triggering details, which might
precipitate overwhelm or flashbacks. It is merely the
naming of the problem, thereby exposing one’s self
to it, and accepting it that promotes the cognitive
shift. Often such work results in the elucidation of
the core issues around which such symptoms organ-
ize. The acupoints are described in Figure 1.
Each time the tapping procedure is concluded,
Figure 1  Anatomical Landmarks for EFT
KC: The Karate Chop (KC) point is located at the center of the
the patient is asked once again to retest the intensity
fleshy part of the outside of your hand (either hand) between the top of the symptom by rating it on the 0 to 10 scale. Very
of the wrist and the base of the baby finger or . . . stated differently frequently, the intensity will be substantially reduced.
. . . the part of your hand you would use to deliver a karate chop. Retapping until the symptom has disappeared can
TOH: On the top of the head. If you were to draw a line from continue to the patient’s satisfaction. Other times,
one ear, over the head, to the other ear, and another line from
the retest may reveal that the patient scores the prob-
your nose to the back of your neck, the TOH point is where
those two lines would intersect. lem even higher than initially tested. Oftentimes this
EB: At the beginning of the eyebrow, just above and to one side can be the result of a new aspect of the problem
of the nose. This point is abbreviated EB for beginning of the presenting itself that can be explored with the patient:
EyeBrow. perhaps the emergence of a new memory, image, or
SE: On the bone bordering the outside corner of the eye. This story connected to the problem that was not initially
point is abbreviated SE for Side of the Eye.
UE: On the bone under an eye about 1 inch below your pupil.
evident to the patient. The more specific the patient
This point is abbreviated UE for Under the Eye. can be regarding these details, the more finely tuned
UN: On the small area between the bottom of your nose and the and successful the tapping process can be as well.
top of your upper lip. This point is abbreviated UN for Under For example, one patient who suffered from a
the Nose. persistent fear of driving insisted there was no logical
Ch: Midway between the point of your chin and the bottom of
reason why she should be so afraid to do so. She
your lower lip. Even though it is not directly on the point of the
chin, we call it the chin point because it is descriptive enough for started tapping: “Even though I don’t know why I am
people to understand easily. This point is abbreviated Ch for Chin. so afraid of driving, I still completely and deeply
CB: The junction where the sternum (breastbone), collarbone accept myself.” As she tapped through the acupoints,
and the first rib meet. To locate it, first place your forefinger on suppressed memories began to trigger, including a
the U-shaped notch at the top of the breastbone (about where a traumatizing driver’s education film that showed
man would knot his tie). From the bottom of the U, move your
forefinger down toward the navel 1 inch and then go to the left
graphic accident videos, a long-forgotten boyfriend
(or right) 1 inch. This point is abbreviated CB for CollarBone whose face was mutilated in a car accident, and a
even though it is not on the collarbone (or clavicle) per se. It is suppressed memory of driving with her father at night
at the beginning of the collarbone and we call it the collarbone during which time they actually ran over a part of a
point because that is a lot easier to say than “the junction where dead body in the road. None of these triggers was
the sternum (breastbone), collarbone and the first rib meet.”
consciously available to the patient at the beginning
UA: On the side of the body, at a point even with the nipple (for
men) or in the middle of the bra strap (for women). It is about 4 of the session; however, as they were released, she
inches below the armpit. This point is abbreviated UA for Under could tap down her distress sufficiently enough that,
the Arm. by the end of the session, she reported absolutely no
Source: Used with permission by Gary Craig, 2015. fear of driving. This effect was sustained at subse-
quent sessions. The patient was able to heal by releas-
old.” As the patient continues to tap through the rest ing the disruption in the energy system, thereby
of the prescribed acupoints (see Figure 1), she/he reconditioning the stress response toward the trigger.
repeats brief follow-up statements to continue to Craig’s (2016) work offers many detailed
help him/her focus on what she/he is trying to instructions as to techniques aimed at producing
release. For example, such follow-up statements more beneficial effects. As this article is merely an

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 Emotional Freedom Technique / Rancour   5

introduction to the uninitiated, the reader is anger that manifests in other relationships as well.
referred to his online tutorial for further detailed Jan reported she developed gestational hyperten-
instructions and numerous embedded web videos sion starting with her first pregnancy, and her blood
that demonstrate the technique. pressure never normalized. She learned EFT for
assistance with stress relief, and now reports since
tapping on a daily basis, that she is slowly weaning
Implications for Nursing Practice, off anti-hypertensive medication that she has been
Education, and Research taking for years.
Eleanor has suffered debilitating migraine head-
Clinical implications abound for many physical aches, which have resulted in numerous missed days
and psychological conditions that patients bring to at work. She rated her headaches as a 14 on a 0 to
the attention of nurses. Patients quickly grasp the 10 scale. As she learned EFT, it was remarkable to
effect of stress, its effects on a super-heated sympa- watch as the head pain, often located behind her left
thetic nervous system, and the effects it has on the eye, would move to other locations in her body as it
psyche and the body. Inflammatory conditions such was tapped down: into her right shoulder, her right
as pain, autoimmune illnesses, and other stress- hip, and so on, and on into her foot by which time
related conditions like PTSD, anxiety, and depres- the pain was often reduced to a 1 to 2. She remarked
sion often respond quickly. The empowerment that that she often received quicker relief without side
comes with learning a self-help tool that patients effects from EFT than she received from taking
can use easily without the need for a prescription or Imitrex, her rescue medication, used to abort
an appointment with a health care provider cannot migraines in progress.
be underestimated. The fact that this technique can The implications for nursing education are no
be learned/administered one-to-one or in a group better illustrated than by using EFT to assist nursing
makes it a very flexible tool. The following case stud- students with their own anxiety (Patterson, 2013).
ies provide examples of clinical applications of EFT. Many colleges of nursing devote considerable
Margaret is a patient with bipolar disorder whose resources to help their students pass state boards.
anxiety can often escalate into panic attacks despite Teaching students EFT can boost academic perfor-
being on mood stabilizers. She has been taught mind/ mance substantially without being costly. As they
body techniques such as guided imagery, biofeedback, themselves benefit from using EFT, they become
and mindfulness, but due to attention deficit disorder, highly motivated to teach it to their patients.
she often neglects her daily practice. She appeared to Nursing research implications abound as EFT can
have difficulties self-monitoring stress levels whereby be studied for a wide variety of its effects on such phe-
she could intervene earlier and head the panic attacks nomena as wide and varied as wound healing, reha-
off. She was taught EFT and is able to tap her anxiety bilitation progress, posttraumatic stress disorder,
attack down from a 10 to a 2 on a scale of 0 to 10 nonpharmacological pain management, addictions
within 4 to 6 minutes. For her to be effective, however, including drug and behavioral cravings, and the ability
she has to set the timer on her smartphone to chime to wean off medications for such inflammatory condi-
every 2 hours to help her stop, take a stress assessment tions as asthma, hypertension, diabetes, and so on.
reading, and intervene as necessary. She believes this
is a small price to pay for regaining control over a cha- Summary
otic day-to-day life. She is working toward reducing
the dosage of her mood stabilizing medication. The Emotional Freedom Technique, or “tap-
Milo presents with historical anger management ping,” is defined as a cognitive/energetic therapeutic
issues that he can trace back to an abusive child- technique designed according to the precepts of
hood. Currently, his rage results in domestic vio- energy principles often found in eastern healing
lence against his wife, who is currently planning to practices. A substantive literature review described a
end their relationship. In the meantime, despite robust 98% efficacy rate, mechanisms of action were
initial skepticism from Milo, he learned in one ses- proposed based on diagnostic testing during and
sion to tap down rage from an 8 to a 2. Unfortunately, post-administration, and the clinical procedure was
while it is not timely enough to save his marriage, he described. Implications for nursing practice, educa-
is getting relief from a life-long scourge of rabid tion, and research were identified.

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6  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX

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